A new systematic review and meta-analysis revealed a number of factors that can make patients with psoriasis have a poorer response to biologics. 

Researchers for the study used data from PubMed, Embase, and Web of Science reporting treatment outcomes using Psoriasis Area and Severity Index (PASI) 75 or PASI 90 at 12, 26, and/or 52 weeks. Randomized clinical trials (RCTs) and observational studies were considered for inclusion, with independent authors screening studies for eligibility. A total of 107 studies were evaluated for possible inclusion, with 40 studies meeting inclusion criteria. The authors used pooled random-effects models and conducted separate analyses for RCTs and observational studies. The primary outcome of interest was PASI 90 at 26 weeks. 

The analysis included data on a total of 21,438 patients across the 40 included studies. For the observational studies, the researchers reported that older age (OR = 0.99; 95% CI, 0.98-1.00), previous exposure to biologics (OR = 0.44; 95% CI, 0.29-0.67), higher body mass index (BMI) (OR = 0.96; 95% CI, 0.94-0.99), previous smoking (OR, 0.81; 95% CI, 0.67-0.98), and current smoking (OR = 0.78; 95% CI, 0.66-0.91) were negatively associated with achieving PASI 90 at 6 months in the observational studies. For the RCTs, only a BMI of 30 or higher was reported as a negative factor linked with treatment response (OR = 0.57; 95% CI, 0.48-0.66).

"It remains unclear whether these clinical characteristics influence treatment response differently for the different biologics available for psoriasis," the authors wrote in their conclusion.

Source: Hjort G, et al. JAMA Dermatology. 2024. Doi:10.1001/jamadermatol.2024.1677